Document Type

DNP Project

Publication Date


Degree Name

Doctor of Nursing Practice

Faculty Advisor

Constance Glenn, DNP, RN

Practice Mentor

Samantha Gelfand, MD


Introduction: Chronic kidney disease (CKD) is a growing public health concern in the United States. People with CKD suffer from many symptoms that cause distress and low quality of life (QoL). Research has found an association between symptom burden in patients with CKD and the disease's worsening progression. There is little data on ways to monitor and address CKD symptoms routinely.

Purpose: The purpose of this project was to identify symptoms related to advancing kidney disease using patient-reported outcome measures (PROMs) through IPOS-Renal survey and implement a nurse-driven protocol to manage patient reported symptoms.

Interventions/Setting: Over a three-month period at the outpatient nephrology clinic in Boston, Massachusetts, patients completed the IPOS-Renal survey before their appointment with the renal nurse to assess uremic symptoms. Once the IPOS-Renal survey was conducted, the nurse evaluated the survey and implemented the agreed-upon interventions. The patients were then asked to fill out another IPOS-Renal survey before their next visit to see if the interventions were effective and whether they had new symptoms that needed to be addressed.

Evaluation: A total of 23 patients were eligible for the QI project. The final analysis included survey data from nine patients who completed both IPOS-Renal surveys. 50% of patients who reported pain, SOB, nausea, poor appetite, constipation, and, itching had full resolution of symptoms after interventions. Patients with weakness/lack of energy had 40% complete resolution and 20% had symptom improvement. Patients who reported drowsiness, 75% reported complete resolution their symptoms. 40% of paints reported improvement of difficulty sleeping. 100% of patients who reported restless leg syndrome and diarrhea reported resolution of symptoms after interventions.

Discussion: Implementing PROMs is allows for a standardized way to assess, treat, and monitor symptoms associated with CKD and ESRD. The results showed benefits to having a consistent way to evaluate, manage, and monitor symptoms of CKD. This protocol also has the potential to be used as a metric on whether the patient needs to start dialysis.


A DNP project submitted in partial fulfillment of the requirements for the degree of Doctor of Nursing Practice, Sacred Heart University Davis & Henley College of Nursing.

Creative Commons License

Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License
This work is licensed under a Creative Commons Attribution-NonCommercial-Share Alike 4.0 International License.



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